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The Association of Overweight and Ankle Injuries in Children

  • Author Footnotes
    ∗ Present address: Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Penn.
    Mark R. Zonfrillo
    Correspondence
    Address correspondence to Mark R. Zonfrillo, MD, Division of Emergency Medicine, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, Pennsylvania 19104.
    Footnotes
    ∗ Present address: Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Penn.
    Affiliations
    From the Department of Pediatrics (Dr Zonfrillo, Dr Seiden, Ms House, Dr Shapiro, Dr Baker, and Dr Spiro) and Department of Epidemiology and Public Health (Dr Shapiro and Dr Dubrow), Yale University School of Medicine, New Haven, Conn
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  • Author Footnotes
    ∗ Present address: Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Penn.
    Jeffrey A. Seiden
    Footnotes
    ∗ Present address: Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Penn.
    Affiliations
    From the Department of Pediatrics (Dr Zonfrillo, Dr Seiden, Ms House, Dr Shapiro, Dr Baker, and Dr Spiro) and Department of Epidemiology and Public Health (Dr Shapiro and Dr Dubrow), Yale University School of Medicine, New Haven, Conn
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  • Ellen M. House
    Affiliations
    From the Department of Pediatrics (Dr Zonfrillo, Dr Seiden, Ms House, Dr Shapiro, Dr Baker, and Dr Spiro) and Department of Epidemiology and Public Health (Dr Shapiro and Dr Dubrow), Yale University School of Medicine, New Haven, Conn
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  • Eugene D. Shapiro
    Affiliations
    From the Department of Pediatrics (Dr Zonfrillo, Dr Seiden, Ms House, Dr Shapiro, Dr Baker, and Dr Spiro) and Department of Epidemiology and Public Health (Dr Shapiro and Dr Dubrow), Yale University School of Medicine, New Haven, Conn
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  • Robert Dubrow
    Affiliations
    From the Department of Pediatrics (Dr Zonfrillo, Dr Seiden, Ms House, Dr Shapiro, Dr Baker, and Dr Spiro) and Department of Epidemiology and Public Health (Dr Shapiro and Dr Dubrow), Yale University School of Medicine, New Haven, Conn
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  • Author Footnotes
    † Present address: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex.
    M. Douglas Baker
    Footnotes
    † Present address: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex.
    Affiliations
    From the Department of Pediatrics (Dr Zonfrillo, Dr Seiden, Ms House, Dr Shapiro, Dr Baker, and Dr Spiro) and Department of Epidemiology and Public Health (Dr Shapiro and Dr Dubrow), Yale University School of Medicine, New Haven, Conn
    Search for articles by this author
  • Author Footnotes
    ‡ Present address: Departments of Emergency Medicine and Pediatrics, Oregon Health and Science University, Portland, Ore.
    David M. Spiro
    Footnotes
    ‡ Present address: Departments of Emergency Medicine and Pediatrics, Oregon Health and Science University, Portland, Ore.
    Affiliations
    From the Department of Pediatrics (Dr Zonfrillo, Dr Seiden, Ms House, Dr Shapiro, Dr Baker, and Dr Spiro) and Department of Epidemiology and Public Health (Dr Shapiro and Dr Dubrow), Yale University School of Medicine, New Haven, Conn
    Search for articles by this author
  • Author Footnotes
    ∗ Present address: Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Penn.
    † Present address: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex.
    ‡ Present address: Departments of Emergency Medicine and Pediatrics, Oregon Health and Science University, Portland, Ore.

      Objectives

      Overweight children are at increased risk for many medical problems. Trauma is the leading etiology of childhood morbidity and mortality. No previous study has evaluated the association between overweight and acute ankle injuries in children. We hypothesized that being overweight is associated with an increased risk of ankle injury in children.

      Methods

      We conducted a case-control study in an urban pediatric emergency department. Subjects aged 5 to 19 years were recruited from June 2005 through July 2006. Children with acute ankle trauma were enrolled as cases. A convenience sample of children with a chief complaint of fever, headache, or sore throat was enrolled as controls. Demographic information and anthropometric measurements were obtained. Age- and gender-specific body mass index percentiles (BMI-Ps) were calculated using pediatric norms. Multivariate unconditional logistic regression was used to assess the relationship between overweight and ankle injury, adjusting for demographic variables. Through medical records, we obtained demographic information and weight, but not height, of all cases that were not enrolled. This allowed us to conduct a sensitivity analysis in which we combined the enrolled and nonenrolled cases into a single case group and made increasingly more unlikely assumptions about the height percentiles of the nonenrolled cases.

      Results

      One hundred eighty cases and 180 controls were enrolled in the study. We observed a significant association between overweight and ankle injury (multivariate-adjusted odds ratio 3.26, 95% confidence interval, 1.86–5.72; P value for trend <.0001). Although this result may be an overestimate of the magnitude of the association due to a possible bias in the selection of cases, sensitivity analysis demonstrated the robustness of the statistical significance of the finding.

      Conclusions

      Overweight children may be at increased risk of ankle injury.

      Key Words

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